Member Evaluation

Waushara County 4-H Educational Experiences & Awards Application Form – Year 2027

Name _________________________

Due Date: ME Forms are due on January 9th to the Extension Office. Please attach page 1 of this application to the appropriate ME form and return on or before January 9th to the Extension Office, 380 South Townline Road, Wautoma, WI 54982. Applications will not be accepted after January 9th. Please note that interviews are on Saturday, January 17th at the Waushara County Highway Department beginning at 1PM.

Interview Date: Saturday, January 17th at Waushara City Highway Dept

Members will complete a trip commitment form within 2 weeks of being notified of selection for an experience/award. Payment of the youth’s portion will be due by the date indicated. Youth choosing not to participate after submitting a signed commitment form are responsible for all trip costs, including the scholarship provided by the Leaders Association.

Indicate your preference with an “X”. Each member may only receive a scholarship for one educational experience per calendar year. Members may participate in each experience/award during the years they are eligible for the number of times listed below:
One Year: American Spirit, Citizenship Washington Focus, National 4-H Congress,
Space Camp, Scholarship, Key Award
Two Years: Summer Academy
All Years Eligible: Explore Wisconsin and Older Youth Trip

The Waushara County Leader Association reserves the right to limit the number of scholarships provided for educational experiences.

• American Spirit East
• Citizenship Washington Focus
• Explore WI
• National 4-H Congress
• Older Youth Trip
• Space Camp
• Summer Academy

Each 4-H member may receive one of the above educational experiences along with either the Key Award or Scholarship.

• Key Award
• Leaders Association Scholarship

American Spirit East: The 4-H American Spirit Experience is an opportunity for youth to immerse themselves in
history and heritage through a 10-day bus journey to the East Coast and Canada. This program will also focus on
career readiness, leadership development, and experiential learning around history and civics, with an emphasis
on diversity and the challenges that different groups of people have faced. Youth currently in grades 8-10 travel to
Nappanee, Philadelphia, New York City, Boston, Lexington/Concord, Gloucester, Salem, and Niagara Falls (passport
required) June 25 -July 3.

Requirements:
Older Member ME Form Due January 9
ME Interview on January 16
Total cost approximately without scholarship $3,000

Citizenship Washington Focus: a national youth leadership experience in Washington, D.C., designed to help
teens discover their passions and build career and life-readiness skills. Through hands-on workshops, immersive
activities, and offsite experiences, participants explore career pathways while developing leadership, problemsolving,
and social entrepreneurship skills. Youth also engage in community-based projects, collaborate with peers
from across the country, and experience the rich history, culture, museums, and monuments of the nation’s
capital. This program is for youth currently in grades 10-12 and will be held on March 15-21.

Requirements:
Older Member ME Form Due January 9
ME Interview on January 16
Total cost approximately without scholarship $2,600

Explore Wisconsin: Youth currently in grades 6-8 spend three nights and four days exploring the cultural,
historical, geographical/geological, political and economic aspects of one geographic region of Wisconsin. This trip
generally takes place in June or July with exact dates determined by delegates as a group.

Requirements:
Younger Member ME Form Due January 9
ME Interview on January 16

National 4-H Congress: annually brings 4-H youth and adults from around the nation to Washington D.C. to
work towards strengthening and expanding the 4-H Youth Development program at the local, state, and national
levels. National 4-H Conference is the U.S. Secretary of Agriculture’s premier youth development opportunity to
engage youth in developing recommendations for the 4-H Youth Development Program. The National 4-H
Headquarters is charged with sharing the recommendations that emerge from the conference with the Secretary
of Agriculture, National Extension Program Leaders, and others who determine 4-H programs. This program is for
youth currently in grades 9-12 dates to be determined.

Requirements:
Older Member ME Form Due January 9
ME Interview on January 16
Total cost approximately without scholarship $1,500

Older Youth Trip: Youth currently in grades 9-13 spend three nights and four days exploring the cultural,
historical, geographical/geological, political and economic aspects of one geographic region in the Midwest. This
trip generally takes place in June or July with exact dates determined by delegates as a group.

Requirements:
Older Member ME Form Due January 9
ME Interview on January 16

Space Camp: a camp experience where you learn and experience a ton of different aspects about life as an
astronaut, working at NASA, and exploring places beyond Earth! Wisconsin 4-H Space Camp participants
experience the Pathfinder Program, a 3-day experience where youth participate in a variety of simulated space
activities at the U.S. Space and Rocket Center! Space Camp is open to youth in grades 6-8 and will be held from
April 30-May 2, 2027, in Huntsville, Alabama.

Requirements:
Younger Member ME Form Due January 9
ME Interview on January 16
Total cost approximately without scholarship $1,300

Summer Academy: is a statewide 4-H youth development experience held on the UW-Madison campus. Youth
explore career and hobby interests through hands-on learning tracks in areas such as agriculture, STEM,
leadership, and the arts while building friendships with peers from across Wisconsin. Participants stay in a campus
residence hall and enjoy seminars, campus tours, guest speakers, performances, and a variety of engaging
activities designed to inspire learning, leadership, and personal growth. Thie event is open to youth currently in
grades 8-11 and will be held June 13-17.

Requirements:
Younger Member ME Form Due January 9
ME Interview on January 16
Total cost approximately without scholarship $600

Key Award: This award recognizes youth that have shown consistent growth in 4-H, have developed their
leadership ability and been helpful to their clubs and community. Two or three youths, typically near the end of
their 4-H career, can be selected for this award. Individuals for this recognition have been nominated by their club
or can be self-nominated.

Requirements:
Key Award ME Form Due January 9
ME Interview on January 16
2025 Record Book Submitted

Leaders Association Scholarship: Two $500 scholarships will be awarded to members graduating from high
school this year or members enrolled in college during the current academic year.

Requirements:
One Letter of Recommendation & Scholarship Application Due January 9
ME Interview on January 16